EFTA00186568¶
| Melavante Corporation Credit Card Services | CREDIT CARD ACCOUNT MAINTENANCE Account Record, Card, PIN | |
| Act# | ||
| Name | For Marital Property States Only | |
| Business Name | NES LLC | Married Not Married Legally Separated |
| Account Record Changes | Spouse's Name Street Address City, State, ZIP | |
| Close Account | ||
| Cards Returned | Cards Not Returned | Order New Card for Must mark below to indicate the type of card ordered |
| Re-Open Account | Remove Reissue Block | Send Card: Normal Delivery - 7 to 10 days |
| Add Soc. Sec.: # | Express Delivery - 2 days ($10.00 charge) | |
| Add Telephone # | Home Business | Saturday Delivery ($10.00) |
| Name Change From: | Faxcard - 1 day ($20.00 charge) | |
| To: | Saturday Delivery ($10.00) | |
| Address Change to City, State, ZIP | ||
| Add Cardholder | Charge: Cardholder Financial Institution Address to Mail Card: Name | |
| Order Card | Do Not Order Card | Street Address City, ST, ZIP |
| Delete Cardholder | Charge Cardholder Replacement Card Fee of $ | |
| Add Authorized User | ||
| Order Card | Do Not Order Card | |
| Delete Authorized User | ||
| Add Credit Rating | Delete Credit Rating | |
| Add Type Code | Delete Type Code | |
| Add Automatic Payment Detuction T/R# | Checking Accr | |
| Minimum payment | Previous balance | |
| Delete Automatic Payment Deduction | ||
| Add Email Address | ||
| Add Mother's Maiden Name | ||
| Add Secondary CH SS# | ||
| Add Secondary CH DOB | ||
| Add Secondary CH Daytime Phone | ||
| Add Fax Number | ||
| Add Cell Phone# | ||
| Add Pager Number | ||
| Privacy Option | ||
| Insurance | ||
| Add Insurance | ||
| If add insurance, attach a signed copy of the insurance application | ||
| Free Text Message/Miscellaneous Instructions | ||
| Officer Code | 001 | |
| Financial Institution Name | 2803 | Date: 7-23-01 |
| Authorized Signature | Bank | Agent # |
| Print Name | Han Luff | Telephone |
| 213999 MORE(1200) | Ext. | |
| Fax to Account Processing. | ||